DHS 105.16 Note
Note: A copy of the CDC recommended universal precautions may be obtained from the Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701.
DHS 105.16(10)(d)
(d) Medical record. The nurse shall maintain a medical record for each recipient. The record shall document the nature and scope of all services provided and shall be systematically organized and readily accessible to authorized department personnel. The medical record shall document the recipient's condition, problems, progress and all services rendered, and shall include:
DHS 105.16(10)(d)2.
2. Appropriate hospital information, including discharge information, diagnosis, current patient status and post-discharge plan of care;
DHS 105.16(10)(d)4.
4. All medical orders, including the physician's written plan of care and all interim physician's orders;
DHS 105.16(10)(d)5.
5. A consolidated list of medications, including start and stop dates, dosage, route of administration and frequency. This list shall be reviewed and updated for each nursing visit, if necessary;
DHS 105.16(10)(d)6.
6. Progress notes posted as frequently as necessary to clearly and accurately document the recipient's status and services provided. In this paragraph, “progress note" means a written notation, dated and signed by a member of the health team providing covered services, that summarizes facts about care furnished and the recipient's response during a given period of time;
DHS 105.16(10)(d)7.
7. Clinical notes written the day service is provided and incorporated into the clinical record within 7 days after the visit or recipient contact. In this paragraph, “clinical note" means a notation of a contact with a recipient that is written and dated by a member of the home health team providing covered services, and that describes signs and symptoms, treatment and drugs administered and the patient's reaction, and any changes in physical or emotional condition;
DHS 105.16(10)(d)8.
8. Written summaries of the recipient's care provided by the nurse to the physician at least every 62 days; and
DHS 105.16(10)(d)9.
9. Written authorizations from the recipient or the recipient's guardian when it is necessary for the nurse to procure medical supplies or equipment needed by the recipient, unless the recipient's care is being provided by an MA-certified home health agency.
DHS 105.16(10)(e)1.1. The recipient shall be informed of the identity of the agency-assigned alternate nurse before the alternate nurse provides services.
DHS 105.16(10)(e)2.
2. The nurse shall document a plan for recipient-specific emergency procedures in the event a life-threatening situation or fire occurs or there are severe weather warnings. This plan shall be made available to the recipient and all caregivers prior to initiation of these procedures.
DHS 105.16(10)(e)3.
3. The nurse shall take appropriate action and immediately notify the recipient's physician, guardian, if any, and any other responsible person designated in writing by the patient or guardian of any significant accident, injury or adverse change in the recipient's condition.
DHS 105.16(10)(f)
(f) Discharge of the recipient. A recipient shall be discharged from services provided by the nurse upon the recipient's request, upon the decision of the recipient's physician, or if the nurse documents that continuing to provide services to the recipient presents a direct threat to the nurse's health or safety and further documents the refusal of the attending physician to authorized discharge of the recipient with full knowledge and understanding of the threat to the nurse. The nurse shall recommend discharge to the physician and recipient if the recipient does not require services or requires services beyond the nurse's capability. The nurse provider shall issue a notification of discharge to the recipient or guardian, if possible at least 2 calendar weeks prior to cessation of skilled nursing services, and shall, in all circumstances, provide assistance in arranging for the continuity of all medically necessary care prior to discharge.
DHS 105.16 History
History: Cr.
Register, February, 1986, No. 362, eff. 3-1-86; am. (intro.), (1) and (2), r. and recr. (3), cr. (4) and (5),
Register, April, 1988, No. 388, eff. 7-1-88; emerg. r. and recr. (1) and (2), cr. (6), eff. 7-1-92; r. and recr. (1) and (2), cr. (6) to (10),
Register, February, 1993, No. 446, eff. 3-1-93; correction in (intro.) made under s. 13.93 (2m) (b) 7., Stats.,
Register, October, 2000, No. 538; corrections in (intro.), (2) (a), (c), (6) (a) (intro.), 2., (7) and (9) (a) made under s. 13.92 (4) (b) 7., Stats.,
Register December 2008 No. 636;
CR 20-039: am. (6) (a) (intro.)
Register October 2021 No. 790, eff. 11-1-21;
EmR2306: emerg. cr. (1m), eff. 5-1-23;
CR 23-045: cr. (1m)
Register January 2024 No. 817, eff. 2-1-24.
DHS 105.17(1)(a)
(a) “Client" means an individual who receives personal care services from an entity certified or required to be certified under this section, irrespective of whether that individual is a medicaid recipient.
DHS 105.17(1)(ag)
(ag) “Delegated act” means an act that is delegated to an RN or L.P.N. by a physician, podiatrist, dentist or optometrist.
DHS 105.17(1)(b)
(b) “Legal representative" means a person who is any of the following:
DHS 105.17(1)(b)2.
2. A person appointed as a health care agent under an activated power of attorney for health care under ch.
155, Stats.
DHS 105.17(1)(b)3.
3. A person appointed as an agent under a durable power of attorney under s.
243.07, 1989 Stats., executed on or before April 28, 1990.
DHS 105.17(1)(c)
(c) “Principal" means an administrator, a person with management responsibility for the applicant, an officer or person owning directly or indirectly 5% or more of the shares or other evidences of ownership of a corporate applicant, a partner in a partnership which is an applicant, or the owner of a sole proprietorship which is an applicant.
DHS 105.17(1c)
(1c)
Requirements. For MA certification, a personal care provider shall be one of the following types of entities and shall meet applicable certification requirements:
DHS 105.17(1c)(e)
(e) A federally recognized American Indian tribe or band in Wisconsin.
DHS 105.17(1e)
(1e)
Contracting, planning and coordination; fit and qualified. A personal care provider shall do all of the following:
DHS 105.17(1e)(b)
(b) Present a proposal to the department to provide personal care services that does all of the following:
DHS 105.17(1e)(b)2.
2. Documents a quality assurance mechanism and quality assurance activities.
DHS 105.17(1e)(b)3.
3. Demonstrates that employees possess knowledge of and training and experience with special needs, including independent living needs, of the client group or groups receiving services.
DHS 105.17(1e)(c)
(c) Provide a written plan of operation describing the entire process from referral through delivery of services and follow-up.
DHS 105.17(1e)(d)
(d) Cooperate with other health and social service agencies in the area and with interested community referral groups to avoid duplication of services and to provide coordination of personal care services to clients.
DHS 105.17(1e)(e)
(e) Be fit and qualified. All of the following factors are relevant to a determination by the department whether the applicant is fit and qualified for purposes of this paragraph:
DHS 105.17(1e)(e)1.
1. Any adverse action against the applicant or any principal by a licensing agency of any state that resulted in denial, suspension, injunction, or revocation of a license to operate a human services or health care agency or facility.
DHS 105.17(1e)(e)2.
2. Any adverse action against the applicant or any principal initiated by a state or federal agency based on non-compliance that resulted in civil money penalties, termination of a provider agreement, suspension of payments, or the appointment of temporary management of a facility or agency.
DHS 105.17(1e)(e)3.
3. Any conviction of the applicant or any principal for a crime involving neglect or abuse of patients or of the elderly or involving assaultive behavior or wanton disregard for the health or safety of others, or any act of abuse under s.
940.285 or
940.295, Stats., or similar law in another jurisdiction.
DHS 105.17(1e)(e)4.
4. Any conviction of the applicant or any principal for a crime related to the delivery of personal care or other health care-related services or items, or for providing personal care or other health care-related services without a license or other form of permission required by law.
DHS 105.17(1e)(e)5.
5. Any conviction of the applicant or any principal for a crime involving a controlled substance under ch.
961, Stats., or similar law in another jurisdiction.
DHS 105.17(1e)(e)6.
6. Any conviction of the applicant or any principal for a crime involving a sexual offense.
DHS 105.17(1e)(e)7.
7. Any prior financial failure of the applicant or any principal that resulted in bankruptcy or in the closing of a human services or health care agency or facility or the relocation or discharge of such an agency's or facility's patients.
DHS 105.17(1e)(e)8.
8. Any unsatisfied judgment against the applicant or any principal or any debts that are at least 90 days past due.
DHS 105.17(1e)(f)
(f) Adopt written policies, procedures and documents that outline agency operations.
DHS 105.17(1e)(j)
(j) Provide for a substitute administrator to act in the absence of the administrator. If it is necessary to immediately terminate an administrator or if the agency loses an administrator for other reasons, employ or name a qualified replacement as soon as possible within 90 days of the vacancy.
DHS 105.17(1e)(k)
(k) Notify the department in writing within 10 days of any appointment or change of the administrator or the substitute administrator.
DHS 105.17(1e)(L)
(L) Notify the department in writing within 10 days of a change in the location of the agency or contact information for the personal care provider.
DHS 105.17(1f)
(1f)
Provision of information. A county, independent living center or federally recognized American Indian tribe or band personal care provider shall provide, in a format approved by the department, identifying information about the county, independent living center or federally recognized American Indian tribe or band and those agencies and individuals that provide Medicaid personal care services through a contract with the county, independent living center or federally recognized American Indian tribe or band.
DHS 105.17(1g)
(1g)
Finances; accounting; recordkeeping; billing. A personal care provider shall do all of the following:
DHS 105.17(1g)(a)
(a) Cash flow. Document adequate resources to maintain a cash flow sufficient to cover operating expenses for 60 days.
DHS 105.17(1g)(b)
(b) Accounting methods. Document a financial accounting system that complies with generally accepted accounting principles.
DHS 105.17(1g)(c)3.
3. A written plan of operations indicating the entire process from making referrals through delivery of services and follow-up.
DHS 105.17(1g)(c)4.
4. A written statement defining the scope of personal care services provided, including the population being served, service needs and service priorities.
DHS 105.17(1g)(cm)
(cm)
Electronic visit verification. The provider is required to capture and retain EVV records.
DHS 105.17(1k)(a)(a) The administrator of a personal care agency shall meet all of the following requirements:
DHS 105.17(1k)(a)2.
2. Have the ability to fulfill the job requirements, respond to the needs of the clients, and manage the personal care agency.
DHS 105.17(1k)(a)3.
3. Have an associate degree or higher in a health care-related field from an accredited college, or a bachelor's degree in a field other than in health care from an accredited college and one year experience working in a health care-related field.
DHS 105.17(1k)(a)4.
4. Have training and experience in health care administration and at least one year of supervisory or administrative experience in home health care or personal care, or a related health program.
DHS 105.17(1k)(a)5.
5. Be knowledgeable about this chapter and s.
DHS 107.112, and take all reasonable steps to ensure that the personal care agency complies with the requirements of this chapter.
DHS 105.17(1k)(a)6.
6. Be responsible for the overall provision of training and competency of all employees.
DHS 105.17(1k)(b)
(b) Persons who are the administrator of record with the department of a personal care agency on the effective date of this rule shall be exempt from the qualification requirements specified under par.
(a).
DHS 105.17(1n)
(1n)
Personnel management. The personal care provider shall document and implement a system of personnel management, if more than one personal care worker is employed or under contract, that includes all of the following:
DHS 105.17(1n)(a)1.1. Evaluate every personal care worker and RN supervisor employed by or under contract with the provider periodically according to the provider's policy for quality of performance and adherence to the provider's policies and this chapter and s.
DHS 107.112. Evaluations shall be followed up with appropriate action.
DHS 105.17(1n)(a)2.
2. Provide orientation and on-going instruction for RN supervisors and personal care workers. Personal care workers shall receive orientation before providing services to a client. The titles of the persons responsible for conducting orientation and training shall be specified in the plan. The plan shall include a system for providing instruction when an evaluation of the RN's or personal care worker's performance or competency indicates additional instruction may be needed. Orientation shall include training on all of the following:
DHS 105.17(1n)(a)2.b.
b. Information concerning specific job duties. Training shall be provided for each skill the personal care worker is assigned and shall include a successful demonstration of each skill by the personal care worker to the qualified trainer, under the supervision of the RN supervisor, prior to providing the service to a client independently. Only an RN may train others on a delegated act, as defined in s.
N 6.02 (5), and s.
N 6.03. The RN or qualified trainer shall document the personal care worker's successful demonstration of each skill and maintain the information in their personnel file.
DHS 105.17(1n)(a)2.c.
c. The functions of personnel employed by the provider and how they interrelate and communicate with each other in providing services.
